Narayana Medical College Hospital Research Articles

Correlational study of Hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis

Background: Appendicitis is an acute and life-threatening situation if not treated promptly encountered in surgery practice. Even today, most cases of appendicitis are diagnosed by clinical findings and imaging. Scanty information is available to diagnose the perforation of the appendix using serological tests; hence, an attempt is made. The present study aimed to find out the correlation of hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis patients. Methods: This prospective observational study was conducted among patients diagnosed with acute appendicitis attending OPD of the general surgery department of Narayana Medical College Hospital. The duration of the study is between January 2023 and December 2023. A total of 400 patients with a diagnosis of either acute appendicitis or perforation were recruited into the study, and they collected blood samples for estimation of hyperbilirubinemia. Results: In the study population of 400 patients, 72 cases were diagnosed as appendicular perforation, and 328 patients had acute appendicitis. The cut-off value of hyperbilirubinemia was taken as serum bilirubin >1.0 mg/dl. Out of 72 cases of appendicular perforations, 64 patients have hyperbilirubinemia (89%), while in the acute appendicitis patients group, 82 of 328 patients have elevated serum bilirubin (25%). The observed mean values of serum bilirubin in the two groups were 1.74 and 0.89, and the difference in the standard error of the mean value of the two groups is statistically significant at a P-value of <0.001. Conclusions: Patients who presented with acute appendicitis symptoms and had serum bilirubin values >1.0 mg/dl had a higher probability of appendicular perforation. Hence, measuring serum bilirubin can be considered an additional diagnostic tool to existing clinical diagnosis and radiological evaluation for more precision in diagnosis.

A STUDY ON SERUM URIC ACID LEVELS IN TYPE 2 DIABETES PATIENTS AND ITS ASSOCIATION WITH CARDIOVASCULAR DISEASE

Backgrond And Objective: This study was done to note the levels of serum uric acid in type 2 diabetes patients with Acute Myocardial Infarction, to correlate the blood uric acid levels with Killip Classication, to study the role of serum uric acid as a marker of short-term mortality in coronary heart disease, to study the relation between serum uric acid and cardiac and CPK-MB in acute myocardial infarction, and to study the relation between serum uric acid and Systemic Hypertension & Diabetes Mellitus in coronary heart disease. This study was done at Methodology: Narayana Medical College Hospital. This is a Descriptive analytical study. It was done for 1 year. Study will be conducted on 70 cases of type 2 diabetes mellitus patients. In the present study serum uric acid positive Results: ly correlated with duration of diabetes and cardiovascular risk factors like obesity (high BMI, abnormal waist hip ratio), hypertension, dyslipidemia and the results were statistically signicant. Conclusion: Serum uric acid levels were signicantly higher in diabetic population.Serum uric acid levels in diabetic patients with CAD were signicantly higher. Serum uric acid above 6 mg/dl in diabetic population is a marker or risk factor for CAD

Impact of Certain Socio-clinical Factors on COVID-19 Preventive Measures among Patients with Chronic Respiratory Diseases: A Cross-sectional Study at a Tertiary Care Centre in Southern India

Introduction: Chronic respiratory diseases are known risk factors for Coronavirus Disease-2019 (COVID-19) associated morbidity and mortality. With the fourth wave of COVID-19 looming in India, it is crucial to prioritise preventive measures at both individual and community levels. However, following the third wave of COVID-19, adherence to preventive measures has declined. Aim: To assess the socio-clinical factors affecting COVID-19 preventive behaviour among patients with chronic respiratory diseases. Materials and Methods: This cross-sectional observational study was conducted at the outpatient department of Respiratory Medicine, Narayana Medical College Hospital, Nellore, a tertiary care centre in Andhra Pradesh, India from March to April 2022. The estimated sample size was 600 patients. Data was collected using a validated questionnaire, and analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 28.1 {International Business Machines (IBM) Corporation}. The association between independent and dependent variables was assessed using binary logistic regression. Results: A total of 671 patients’ data were analysed. The mean age was 51.45 (±14.397) years, with 390 (58.1%) being male. Among the participants, the prevalence of wearing face masks in workplaces was 47.8%, wearing face masks in public places was 43.6%, frequent hand sanitisation was 39.9%, and maintaining physical distance in public areas was 35.2%. The main factors associated with non adherence were women, rural dwellers, non smokers, patients with co-morbidities, those who had not experienced a detrimental impact of COVID-19 on themselves, and the perception that COVID-19 was a mild disease. Conclusion: Among patients with chronic respiratory diseases, the practice of COVID-19 preventive measures was inadequate. Factors that positively influenced COVID-19 behaviour were being married, having a high school education level or above, and being a smoker. The impact of age varied depending on the type of preventive measure. Socio-economic status had no significant impact.

Hair Dye Poisoning Patterns among Population in Nellore State Andhra Pradesh

Background: Hair Dyes are chemicals that are used to change hair colour. Hair colouring has become irresistible fascination to improve physiognomy especially people having grey hair. Hair dyeing is an ancient art and hair colourants are rapidly growing globally. But sometimes it is used to commit suicide. Hair dye poisoning occurs when someone swallows’ dye or tint used to colour hair. Morbidity and mortality due to poisoning have been known to pose a significant burden on the health. Aims and Objectives: To study the incidence and demographic features of hair dye poisoning in people who are admitted in Narayana Medical College Hospital, Nellore district State Andhra Pradesh South India. Type of Study: This is a two years prospective study. Place of study: Hair dye poisoning admitted in Narayana Medical College Hospital between the periods July 2012- June 2014. Material and Methods: All patients admitted and managed for hair dye poisoning were retrieved and data collected. Age, sex, incidence, residence, education and marital status were all recorded on the prepared proforma. Observation and Discussion: In our study, age wise distribution of 76 cases of paraphenylenediamine (PPD) hair dye poisoning revealed that maximum cases (56.6%) were in the age group 21–30 years with 27.96 ± 11.24 years mean and standard deviation respectively. Hair dye poisoning was common among females (76% of all cases). The incidence of hair dye poisoning was 154.84 patients of hair dye poisoning/1000 cases of all poisoning/year from July 2012 to June 2013 and 112.90 patients of hair dye poisoning/1000 cases of all poisoning/year during July 2013 – June 2014. Rural people (52.60%) consumed hair dye poison more than urban population. More common in under matriculation. Maximum persons (78.9% of all cases) were married. Conclusion: Trend of hair dye consuming is increasing now a days among young, rural population. It is common among female, married persons and increasing burden on health care institution.

A study to assess the knowledge regarding standard safety precautions in labour ward among nursing students posted at Narayana Medical College Hospital, Nellore, Andhra Pradesh

A study to assess the knowledge regarding standard safety precautions in labour ward among nursing students posted at Narayana Medical College Hospital, Nellore, Andhra Pradesh

Assessment of Left Atrial Volume Index in the Patients with ACS in Adults

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death universally. The present study was conducted to assess LA volume index (LAVI) in the patients with ACS in adults.Subjects and Methods: The present study was conducted on120 adult patients diagnosed with ACS of both genders in narayana medical college hospital from May 2016 toOctober 2016. Patients were divided into 2 groups of 60 each. Group I patients had LAVI > 34 ml/m2 and group II patients had LAVI ≤ 34 ml/m2. The LV systolic function was analyzed by Simpson’s disc volumetric method. The LAV was assessed by the biplane area‑length method from apical 4‑chamber and 2‑chamber views.Results: The mean BMI in group I patients was 26.7 kg/m2 and in group II was 26.1 kg/m2, AW STEMI in group I was seen in 30 patients and in group II in 32, IW + PW STEMI in 6 and 4 patients in both groups respectively, IW STEMI in 5 and 4 patients respectively, NSTEMI in 4 and 3 patients respectively and UA in 15 and 17 patients respectively. Risk factors were diabetes mellitus in 32 and 27 patients respectively, hypertension in 41 and 40 patients respectively, smoking in 43 and 38 patients respectively, alcohol in 30 and 35 patients respectively and positive family history in 12 and 16 patients respectively. The difference was non- significant (P> 0.05). The mean LAVI at admission in group I was 38.1 and in group II was 27.2, after 1 month was 40.2 and 28.1 in both groups, after 6 months was 39.1 and 27.9 in both groups and after 12 months was 42.7 and 25.3 in both groups respectively. The difference was significant (P< 0.05).Conclusion:Authors conclude that LAVI was found to be the independent predictor of mortality than left ventricular ejection fraction on multivariate regression analysis. Common risk factors in patients with ACS were diabetes mellitus, hypertension, smoking, alcoholism and positive family history. Patients with LAVI of value >34 ml/m2 were associated with increased comorbidities.

Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.

Study on ultrasound observations in children with typhoid fever in a tertiary care hospital

Background: Enteric fever continues to be endemic in poor countries globally, although it has been eradicated from the developed nations due to their well-organized sanitation and protected water supply. The five Fs most concerned with spread of typhoid disease are fingers, food, fomites, flies, and feces. Enteric fever is predominantly caused by Salmonella typhi and next in frequency is Salmonella paratyphi. Very less literature is available on radiological manifestations of typhoid fever in children on the basis of age difference in India. Hence, a study was conducted to observe the radiological findings and to correlate with laboratory manifestations in typhoid fever. Objectives of the study was to observe the ultrasound abdomen changes in Typhoid fever at rural area.Methods: The current study was conducted at Department of pediatrics of Narayana Medical College Hospital, Nellore, Andhra Pradesh state in a period of one year. All patients presenting with fever having positive for Widal test were included. In total 50 patients were included and divided into 2 age groups, <5 years and >5years. The laboratory results and abdominal ultrasound were conducted in the two groups and compared.Results: Total 20 patients in <5 years age and 30 patients in >5 years were enrolled. Male to female ratio was 2:1 in both groups. Common laboratory findings showed 32 patients (64%) with Anemia, elevated liver enzymes in 40 patients (80%), and elevated ESR in 42 patients (84%). 45 patients have Splenomegaly and hepatomegaly with normal parenchymal echotexture. Gallbladder sludge and biliary sludge was seen in 6 patients. Thickened gall bladder in 34 patients (68%) was observed. Bowel wall thickening seen in 32 patients (64%). mesenteric lymphadenopathy in 36 patients (68%) observed. All were recovered by treatment.Conclusions: On ultrasound, splenomegaly, hepatomegaly, and thick-walled gallbladder were observed in most of the childrens with typhoid fever. Therefore, ultrasound can also be used as supportive diagnose along with laboratory parameters due to it is a non-invasive and economical tool of diagnosing typhoid.

A study on breastfeeding initiation in low birth weight and very low birth weight babies and their developmental outcome with special reference to kangaroo mother care

Background: Kangaroo Mother Care (KMC) was developed for caring of low birth weight (LBW) babies in developing countries. Study was done with the objective to evaluate the factors affecting initiation of breast feeding and effect of Kangaroo Mother Care (KMC) on morbidity problems and developmental outcome in Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) babies.Methods: Prospective follow-up cohort study was carried out at Neonatal Intensive Care Unit (NICU) at Narayana medical college hospital Nellore from January 2018 to December 2019 and details of neonates were recorded on prestuctured proforma. Kangaroo mother care was given to one group. ASQ 3 questionnaire was used to assess the developmental outcome of the infants.Results: In this study, 100 babies were divided into two groups, case group consists of 50 babies where KMC is given and another control group consists 50 babies where KMC is not given. Mean gestational age for case and control group babies were 34.5 and 33.7 weeks respectively. Mean Birth weight in cases (1700 gr) and control (1580) grams respectively. Number of Male babies were more in cases (51%) and Group B (53%). Main factors affecting the initiation of breastfeeding in babies are LSCS (62% and 48%), RDS (50% and 40%), Apnea (24% and 25%) and seizures (20% and 14%) respectively in case and controls. Rates of exclusive breastfeeding is significantly increased in cases (90%) when compared to control (72%). Morbidity in cases is comparatively lesser than controls. At 6 months of corrected gestational age, mean weight in cases (5.2 kg) is significantly more than mean weight in control (4.7 kg). Significant development is noticed in communication (p=0.036), gross motor (0.04), and fine motor (0.05) compare to controls. Percentage of babies who acquired better personal social skills are more in cases (80%).Conclusions: The main factors affecting the initiation of breastfeeding in LBW and VLBW babies are LSCS, RDS, not secreted milk and seizures. KMC helps to achieve smooth and early transition to direct breastfeeding, increases the exclusively breastfeeding rate, better growth and developmental outcome and reduces the morbidities in LBW neonates.

Impact of Accelerated Recovery Program on Compassion Fatigue among Nurses in South India.

Background:Nurses suffer from Compassion Fatigue (CF) when exposed to chronic stress while caring for patients. Depression and anxiety disorders can develop following CF and intervention at the earliest is essential. The present study aimed to evaluate the effectiveness of the Accelerated Recovery Program (ARP) on CF among nurses.Materials and Methods:The present experimental study was carried out with a pretest posttest design and control group among 120 nurses working in Narayana Medical College Hospital, India. The nurses selected through simple random sampling were divided into two groups: intervention and control (every 60 nurses). Data were collected using the Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Version 5 (ProQOL) (Stamm, 2010) which consists of the three subscales of Compassion Satisfaction (CS), Burnout (BO), and Secondary Traumatic Stress (STS). The pretest was conducted at day 1, and posttests I, II, III, IV, and V were conducted at 5th week, 3rd month, 6th month, 9th month, and 12th month, respectively using ProQOL. ARP and routine care were implemented for 5 weeks in the intervention group, and routine activities were implemented in the control group. Data were analyzed using descriptive and inferential statistics.Results:There was a statistically significant difference in the ProQOL score between the intervention and control groups, which demonstrated a significant difference between the groups in terms of CS (F1,118= 120.10, p < 0.001), BO (F1,118 = 123., p < 0.001), and STS (F1,118 = 205.18, p < 0.001).Conclusion:In conclusion, ARP has a significant impact on ProQOL, resulting in an improvement in CS, and a decrease in BO and STS.

Evaluation of factors responsible for lactation failure-hospital based study

Background: Exclusive breastfeeding is an essential part of early infant feeding. Promotion of EBF is the most effective way to reduce the infant mortality rate. This study was carried out to identify factors affecting EBF among mothers attending Narayana medical college hospital Nellore. Aim and objectives of the study was to know the incidence of lactation failure and to evaluate the factors responsible for lactation failure.Methods: Hospital-based cross-sectional study conducted from July 2018 to September 2018 involving a total of 100 mothers with the help of a proforma containing predesigned questionnaire. Demographic data of mother, obstetric details, mode of delivery, birth weight, details of antenatal advice about breastfeeding and practices, pre-lacteal feeds, current feeding practice, problems encountered during breastfeeding, anatomical problems were noted. The data collected were tabulated and statistically analyzed.Results: At the end of the study, among 100 mothers, 24 mothers are reported to have lactation failure and feeding babies with formula feeds. Among the variables taken into consideration pre-lacteal feeds, problems encountered during breastfeeding, breast diseases showed a statistically significant association with lactation failure. Mean weight gain in breastfeeding mothers and mothers with lactation failure is 11.3 kgs and 10.04 kgs respectively. Mean hemoglobin in breastfeeding mothers and mothers with lactation failure is 10.43 g/dl and 9.91 g/dl respectively.Conclusions: The results provide information about the relation between breastfeeding failure and its association with factors that contribute to it.

Study on etiology and clinical course of neonatal seizures and their outcome

Background: The aim was to explore etiology, clinical course of neonatal seizure sand their and outcome in Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.Methods: Retrospective study of 65 neonates from 1 month to 1 year diagnosed with epilepsy between November 2016 to August 2018.Results: Most common type of seizures seen are subtle (40%), followed by multifocalclonic (20%), tonic (21%), focal clonic (9.2%), clonic (7.7%) and myoclonic (1.6%). Most common cause of neonatal seizures was HIE (41.5%), followed by hypoglycemia (13.8%), intracranial bleed (10.8%), septicemia (10.8%), hypocalcemia (7.7%). The morality percentage is high (18.2%) when seizures occurred before 12 hours, when seizures occurred between 24-48 hrs it is 14.3%, and mortality was least when seizures occurred between 2-6 days (12.5%). Seizures are common in stage IIHIE (81.5%) compared to Stage I &amp;Stage III. Seizures with adverse outcome are generalized myoclonic and focal clonic seizures. Focal clonic and focal tonic seizures are most often associated with focal injury. Generalized tonic seizures, motor automatism and some myoclonic seizures are associated with diffuse brain injury. Prolonged seizure activity, seizures lasting for many days, repetitive seizures, and the need for multiple anticonvulsants to control seizure activity are associated with an increased mortality.Conclusions: Authors conclude that prompt recognition, evaluation and treatment of these neonatal events are important in improving the survival of neonates with seizures.

A study to assess the knowledge on disaster management among staff nurses at Narayana medical college hospital, Nellore, Andhra Pradesh

A study to assess the knowledge on disaster management among staff nurses at Narayana medical college hospital, Nellore, Andhra Pradesh

Knowledge regarding deep breathing exercises on respiratory function among asthmatic patients in Narayana medical college hospital, Nellore, Andhra Pradesh

Knowledge regarding deep breathing exercises on respiratory function among asthmatic patients in Narayana medical college hospital, Nellore, Andhra Pradesh

Level of parental anxiety among mothers of hospitalized children in Narayana Medical College Hospital, Nellore

Level of parental anxiety among mothers of hospitalized children in Narayana Medical College Hospital, Nellore

Knowledge regarding learning disabilities among parents of school going children admitted in Narayana medical college hospital, Nellore, Andhra Pradesh

Knowledge regarding learning disabilities among parents of school going children admitted in Narayana medical college hospital, Nellore, Andhra Pradesh

Knowledge regarding Pap smear among staff nurses and nursing students in Narayana medical college hospital, Nellore, Andhra Pradesh

Knowledge regarding Pap smear among staff nurses and nursing students in Narayana medical college hospital, Nellore, Andhra Pradesh

Changes in the physiological parameters of newborns in the first one hour of life

Background: The transition from a fetus to a newborn is the most complex adaptation that occurs in human experience. This study assessed three physiological parameters viz. temperature (core and peripheral), oxygen saturation and heart rate so as to avoid the delay in normal transitional adaptation.Methods: This cross-sectional observational study was done at Narayana Medical College Hospital, Nellore, Andhra Pradesh, India. A total of 150 neonates born from June 2017 to February 2018 were monitored for heart rate, oxygen saturation, core and peripheral temperature from birth to 60 minutes.Results: Most of the mother’s (45.33%) were aged between 22 to 25 years and the mean age was 23.75±3.64 years. History of consanguineous marriage was noted in 33.33%. The mode of delivery was vaginal in 70.67% of the babies. The mean gestational age was 38.74±1.36 weeks. The birth weight among 62% of the babies was between 2.5 to 3.49 Kgs and mean birth weight was 2.81±0.49 kgs. The meconium stained liquor and requirement of resuscitation was noted in 9.33% and 10.67% respectively.Conclusions: Significant difference was noted with regard to heart rate in babies with active resuscitation, low birth weight (&lt;2.5 kg), meconium stained liquor and warmer care compared to normal babies. There was variation in oxygen saturation in babies who required resuscitation and warmer care, and those who had low birth weight. The mean peripheral and core temperature were different in babies with abdominal care compared to warmer care.

An Observational Study to Assess the Knowledge Regarding Physical Examination among III Year GNM students at Narayana Medical College Hospital, Nellore, Andhra Pradesh

Background: Physical examination is an integral part of nursing care. It is the basic nursing care. A good physical examination leads to identification of the client – status, strengths and concern for nursing diagnosis. This provides discretion for nursing implementation and alleviation of client concern. Assessing a client health status is a major component of nursing care. A complete health assessment may be conducted starting at the head and proceeding in systematic manner downward (head-to-foot) assessment. Aim: The aim of the study was to assess the level of knowledge physical examination. Objectives: 1. To determine the level of knowledge regarding physical examination among IIIrd year GNM students. 2. To associate the level of knowledge with selected demographic variables. Methodology: 30 III yr GNM students posted at Narayana Medical College Hospital were selected by using simple random sampling method. Results: Regarding the level of knowledge among GNM III yr students, 6, (20%) had adequate knowledge, 22(73.3%) had moderate knowledge and 2(6.6%) had inadequate knowledge regarding physical examination.

A Study to Assess the Knowledge and Practice of Various Splints Among Staff Nurses Working in Narayana Medical College Hospital, Nellore, Andhra Pradesh

Background: Splints may be used in all stages of musculoskeletal injuries. Initially, splints may be used for fractures because they are not circumferential there by accommodating swelling without risks of constriction. They are easy to apply and remove, allowing for monitoring of soft tissue and skin integrity. A splint may be definitive treatment for sprains and some fractures. Splints may also be used after initial treatment with casting to provide continued support. There are various forms of splints made of wood states to prefabricated splints and immobilizers are pneumatic walker and wrist immobilization. Aim: The aim of the study was to assess the level of knowledge and practice of staff nurses regarding various splints. Objectives: 1. To assess the knowledge and practice regarding admission process. 2. To find an association between knowledge and practice with socio demographic variables. Methodology: 100 staff nurses working in NMCH, Nellore were selected by using convenience sampling method. Results: Regarding the level of knowledge among staff nurses, 15(15%) of students are had good knowledge, 75(75%) of them had average knowledge and only 10(10%) of them had poor knowledge regarding various splints. Among 100 staff nurses, 20(20%) of them had good practice 66(66%) of them had moderate practice and 14(14%) had poor practice.